Synergistic pathways to delusions: enduring vulnerabilities, proximal life stressors and maladaptive psychological coping

Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis

Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.

Religious Delusions in a Xhosa Schizophrenia Population

Here, we assessed for the first time the frequency of religious delusions and the effect of treatment on religiosity and the phenomena of religious delusions in a Xhosa schizophrenia population. Religious delusions were present in 42 (70%) participants, and treatment significantly reduced religiosity (p = 0.02) as well as mean scores for certain phenomena associated with the delusions including changes in both thinking (p = 0.0001) and behaviour (p = 0.0001), as well as affective response to the delusion (p = 0.0001) The high frequency of religious delusions may indicate a higher tolerance for religious delusions in this community. It is therefore important to educate spiritual leaders on mental illness.